Women doctors, their ranks growing, transform medicine

The Boston University School of Medicine, class of 1885. The school was the nation's first to admit women, and this is its earliest known photo of women and med students.
(Boston University Alumni Medical Library photo)

By Mary Hegarty Nowlan, Globe Correspondent | October 2, 2006

Over the last quarter-century, women have entered the field of medicine in unprecedented numbers, changing not only its face but its character.

As they have dealt with the competing demands of professional and personal life, many women doctors have brought a different approach to the examining room and refused to work the schedules that had long been a badge of honor.

Wendy Levinson, the chair of medicine at the University of Toronto and an international expert on patient/physician relationships, said the number of women physicians has increased so dramatically that it's time to readjust the question from ``Are women getting ahead?" to ``What are women doing to healthcare?"

Nearly half of medical school students nationwide are now female, and as they enter the profession, they are making patient care friendlier and therefore may be less likely to get sued than male physicians. Women physicians also are more likely to serve minority, urban, and poor populations and are twice as likely to go into primary care.

But women physicians' desire to balance work and home life has also caused a seismic shift in practice patterns: Female doctors work fewer hours than men, according to the American Medical Association, with 33 percent of female pediatricians working part-time, compared with 4 percent of male pediatricians.

The implications for the physician workforce are significant. The American Association of American Medical Colleges is projecting a 100,000-physician shortfall by 2020 and asking all medical schools to increase enrollment by 30 percent. That expected shortage can be pegged to a variety of factors, including the aging of the population, the impending retirement of nearly one-third of all practicing doctors -- and the feminization of medicine.

``There are growing reports that the newest generation of physicians do not desire to work the long hours of physicians in the past," according to last month's issue of the group's journal, Academic Medicine. ``Gender plays a role."

Women physicians have helped make it more acceptable for both genders to try to strike a balance between work and family life. ``The new generation is much less driven to work long hours," said Nathalie Feldman, a gynecologist in Essex Junction, Vt. Younger physicians ``are going into emergency medicine, or anesthesia, where you have to work, but there's no call," said Feldman, who remembers when she was in training in the early 1990s, having her infant daughter brought to the hospital parking lot between clinics so she could nurse. ``They have a much clearer sense of what their priorities are going into it than I did."

Female doctors in training now outnumber men in dermatology, family medicine, psychiatry, pediatrics, and OB/GYN. And in internal medicine, the country's largest specialty, women are closing in fast, now accounting for 42 percent of all interns.

Women tend to cluster in specialties that are more accommodating of women and part-time work, notably pediatrics and obstetrics, in which two-thirds of trainees are now female. But these same specialties may be of little use to the aging and medically demanding baby boomers soon to be more in need of orthopedists, pulmonologists, and cardiologists. Currently, fewer than 10 percent of thoracic and orthopedic surgery residents are women.

Women doctors' preference for family practice may also mean that eventually some male patients won't have access to a male primary care provider -- and might be less likely to seek medical care. ``For years, women have argued that it would be good for women to have care from a woman," said Levinson. ``Men might want the same choice. Will we make it available?"

There's little that medical schools can do by themselves to address this mismatch. Women don't apply to medical school with the idea of picking a specialty that will allow them to balance work and family, said Steven E. Hyman , provost of Harvard University and professor of neurobiology at Harvard Medical School.

``But then, . . . frankly, they look at the diminished autonomy, or the decreased compensation and enormously hard work, and they meditate on their lives and think about work/life balance," he said. And then younger physicians of both genders -- but particularly women -- shy away from demanding specialties like surgery.

The real problem: Career building and family building take place during the same years.

``We have to pay attention to how to make [certain specialties] more compatible with work/life balance," Hyman said. ``Or we won't have a workforce."

For the typical patient, having a woman physician means longer office visits. They typically spend more time talking with and counseling patients, according to a 2002 analysis in the Journal of the American Medical Association.

That extra time may also mean a longer wait to see a doctor. A full-time male doctor typically sees 102 patients per week; a full-time female doctor, 87. The discrepancy is aggravated by the fact that women tend to draw more patients into a practice at the same time that they are more apt to work part-time.

Having a part-time doctor can be good for patients, too. Working part-time helps doctors avoid burnout, said Jennifer Shu, a pediatrician in Atlanta who recently left a part-time position at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

``Patients want someone who is happy and fresh and enjoys working," Shu said. Part-time physicians ``will also do shift work, flex time, work on evenings or weekends. It's no longer a 9-to-5 world. [Parents won't] have to miss work every time a kid is sick."